Euthanasia transforms Hippocratic oath into medical hypocrisy

One of Peter Singer's more popular views is that we ought to legalize physician-assisted suicide and, in some cases, active euthanasia of the terminally ill. Doing so, the argument goes, would allow terminally ill men and women to end their pain and die dignified deaths, free from the tubes and invasive measures all too commonly used to save seemingly doomed patients. However, the potential for abuse makes legalized physician-assisted suicide and euthanasia a dangerous course to follow.

In 1981, a Dutch court in Rotterdam ruled that both physician-assisted suicide and active euthanasia were legal so long as they conformed to nine criteria — among them, that the patient must be suffering unbearably, the patient must be fully informed of alternatives and the patient must be conscious when expressing the desire to die. In 1985 and 1986, Dutch courts ruled in two separate cases that euthanasia and physician-assisted suicide were legal when a patient was chronically but not terminally ill, and when a person — in that case, a Down syndrome baby — could neither consent to, nor reject, euthanasia.

In the early 1990s the Netherlands government conducted a study of physician-assisted suicide and euthanasia that became known as the Remmelink report. For the year 1990, it documented 2,300 cases of voluntary euthanasia, 400 cases of physician-assisted suicide and more than a 1,000 cases of non-voluntary euthanasia. The report's authors estimated that 14 percent of these last cases involved fully competent patients, and an additional 11 percent involved partially competent patients who never voiced permission for their deaths. Other evidence indicated that doctors may have pressured patients into prematurely ending their lives. The report cited the following story, told by Richard Fenigsen, M.D., as an example of the potential pitfalls of allowing physicians to recommend suicide:

"Mrs. P. was a 72-year-old widow who, after a bad myocardial infarction, was left with a grossly enlarged heart and congestive heart failure. She was treated . . . and for a whole year had almost no symptoms at rest. True, she needed help cleaning the house, and her only exercise was walking a few blocks . . . Mrs. P. was an extremely nice, mild-tempered lady who never showed any impatience and complied with the doctor's every order and advice.

"When she once failed to appear at the outpatient clinic, I was very much worried. Responding to my inquiry, her family physician . . . paid me a visit. He had had a talk with Mrs. P., he said, and explained the situation to her: This wasn't going to be any better, and living such a limited life, with all those pills, made no sense at all. Mrs. P. accepted everything he said. He stopped her pills, and three days later she died."

Although Mrs. P. chose to stop taking her pills and forfeited her life, her doctor clearly influenced her decision. Many individuals, particularly the elderly in ill health, must place a great deal of confidence in their physicians and consequently are inclined to follow their advice. As a human being with values distinct from those of his patients, a doctor may unintentionally cause a terminally or even chronically ill patient to undervalue his own life. No doctor who has pledged his life to healing the sick should so profoundly violate his patient's trust, and encourage a patient to end a life that might, in fact, be deemed worth living.

The Remmelink report provides strong evidence that legalizing physician-assisted suicide and euthanasia will result in doctors murdering patients. A Dutch poll indicates that 60 percent of the elderly in the Netherlands fear a doctor may end their lives against their will, a horrifying breakdown of trust between patients and the people they depend on most. Any society considering legalizing physician-assisted suicide and euthanasia needs stringent controls to prevent doctors from abusing their newfound power to kill. Until we can implement such controls, we cannot expose our sick and elderly to a medical establishment empowered to end their lives. Peter Harrell is from Atlanta, Ga. He can be reached at pharrell@princeton.edu.